Provider Demographics
NPI:1649811126
Name:FERGUSON, OLIVIA FAITH
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:FAITH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:FAITH
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0071
Mailing Address - Country:US
Mailing Address - Phone:541-206-8376
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3871
Practice Address - Country:US
Practice Address - Phone:541-686-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker